Onboard flight rescue

Nurses resuscitate heart-attack victim

Sophia Loo, RN, and Angela Bingham, RN, barely made their connecting flight to San Jose. The veteran cardiac care nurses at Stanford Health Care were on their way back from a December health-care conference in Orlando, Fla.

As they settled into their seats, Loo heard a woman a few rows ahead of her saying, “Sir, sir, are you OK?” and then, “I think this man needs help. Can someone help him?”

Loo saw a male passenger who appeared to be in real trouble. He was pale, unresponsive, sweating and breathing in a way that Loo recognized immediately. Called agonal respiration, the breathing pattern is accompanied by a snoring sound and comes in gasps, and is often a sign of imminent cardiac arrest. Bingham, seated a few rows back, had noticed the commotion and was on her way to help, when she heard Loo call out, “Angela, get up here!” Other passengers had left their seats, blocking the aisle, forcing Bingham to crawl over empty seats to get to the passenger.

Bingham and Loo had resuscitated many cardiac patients during their careers at Stanford Health Care, which is part of Stanford Medicine. “That’s part of the job,” Loo said. “But in the hospital we have the proper equipment.”

Springing into action

Both nurses knew that they had to start cardiopulmonary resuscitation immediately. “But we couldn’t do CPR while he was in the seat,” Loo said, so she recruited three passengers to maneuver the man into the aisle. He was in his late 60s, she estimated, and weighed about 180 pounds. In the narrow aisle, there wasn’t much room.

“It was surreal,” Bingham said.

“We just went into nursing mode,” Loo said, “but the stress was beyond anything I’ve ever known as a nurse. We were so focused on what we were doing — we knew the gravity of his condition.”

Lacking a ventilating device to help deliver air through the passenger’s nose and mouth — and because he occasionally gasped and opened his eyes, which would have interfered with rescue breaths — the nurses focused on chest compressions, conducted at a rate of 100 times per minute.

A shock to the system

Flight attendants brought them the automated external defibrillator that the Federal Aviation Administration requires all commercial aircraft to carry, giving the two nurses their first chance for an objective reading of the passenger’s heart activity.

This type of defibrillator uses two adhesive-backed leads, which are placed on the skin of the chest to evaluate heart rhythm and deliver an appropriate shock. The device showed that the man’s heart was in a life-threatening rhythm and advised a shock. “I told the flight attendant to press the button to deliver the shock. We called out, ‘Everybody clear!’ and the shock did deliver,” Bingham said.

Protocol dictates that the shock be followed by three minutes of CPR. When they did a second read of the defibrillator, it instructed, “No shock.” That advice, Bingham said, arises when there is no heart activity at all. But the two nurses continued to perform CPR. At one point, the man opened his eyes, Bingham said, “so we knew something was happening, that we were getting through.”

More help arrives

Except for the sound of the CPR count, the other passengers on the plane were silent. “People were in shock, I think,” Loo said. “We lost track of time, but it was at least 15 minutes until a security person came to help us with CPR.”

Paramedics finally arrived to help, too. By the time the passenger was carried out of the plane — the aisle was too narrow for a gurney — he was conscious again, Loo said.

Loo and Bingham were rewarded with a round of applause from onlookers on the aircraft, and someone called out, “Great job!” The nurses have not heard anything further about the man’s condition but say they hope he continues to do well.

The experience, said Loo, “reinforced why I went into nursing. I was so humbled and grateful that I could do something, that Angela and I knew what to do.”